There are new ways to stop  any side effects, to give less IVIg and get better results based on cutting edge research by CIDPUSA.  By using  subcutaneous IVIg. We know how to do to do that and help a patient in 24 hours rather then wait months. You only infuse 1/10 of the dose.

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                          What is IVIG   or Intra Venous Immunglobulin

Below is copyright material. Help youself try a effective treatment in our e-book before IVIg

1. What is  IVIG or Intravenous Immune Globulin?

           IVIg is a collection of antibodies called IgG.

IVIg is a plasma product formed by taking antibodies from about 20,000  donors and mixing them together. infusion of IVIg has proven effective in several immune deficiency disorders, including nearly all autoimmune conditions including CIDP and GBS. The sooner you treat the patient with IVIg the better the results. There is a short window of opportunity usually within the first 18 months after the diagnosis. Treatment with IVIg within the window period is likely to halt the progress of the disease.

After being exposed to toxins and poisonous chemicals including carbon monoxide the body's immune system may mount a attack on the body. This autoimmune attack can be halted by any anti-inflammatory treatment  including IVIg.

2. How does IVIG work? 

IVIg is used in immune deficiency where the body does not make enough antibodies, IVIG  supplies them. For autoimmune disorders like GBS & CIDP, there is a abnormal antibody (autoantibody) being formed which is inactivated by IVIG.

Patients with autoimmune disorders like CIDP also are deficient in antiidotype antibodies. IVIG supplies them. Antiidotype antibodies are normal antibodies which are produced in the absence of any antigen. They are capable of inactivating many different types of antigens.

3. How long does it take to a IVIG treatment to have a effect? 

After IVIg is infused patients may see a response in 24- 48 hours. Some patients will have to wait 3-4 weeks to see an effect. In a few no effect may be seen. If 4-5 cycles of IVIg do not show any response then try a different approach like plasmapheresis, cytotoxic, immune suppressants and antibiotics.

Everyone is slightly different as it depends on how long has the disease process been going on. The sooner one treats it the disease the faster the response.

4. Why is IVIG so expensive? 

IVIg is obtained from plasma donors who are paid then the plasma is sent to  a processing centers for mixing, antibody removal, chemical treatment and filtration to remove viruses. This  is followed by the  products to be freeze dried. All this ends up for IVIG to be priced at $ 48 to $ 60 a gram (cost price of IVIg). A single infusion of IVIg may cost about $3000 for a child to $10,000 for adults. For a child the cost is lower as a small IVIg dose is used. If you have insurance you will see the cost of infusion may go to 100,000.

The cost of IVIg in India & Pakistan $46 a gram, lower prices are found in China where the manufacturer will see IVIg for $10- a gram. This price has doubled in the last year, causing CIDPUSA to shift towards recommending antibiotic treatment. The antibiotic treatment may give faster results without any infusion and cost $100.

5. How is IVIG  administered?

IVIG is mixed in a bag and a tube runs from it to a vein usually in the arm. The recommended way to infuse includes a pump. Usually IVIg is infused at a rate of 100 cc/ hour to 200 cc/ hour.

The rate of IVIg is reduced for any problems such as headaches, rash, fatigue, hypertension or hypotension.  For an adult's IVIg infusion is usually given over  5 to 6 hours.  Dr Dalakas mentioned in his study that precise control of  IVIG infusion is required.

6. What are the common side effects OF IVIG?

IVIg at times causes  patients to get a headache, which is more common in females with a history of Migraines. after IVIg infusion some Patients may experience fatigue similar to getting a Flu, which is due to antibodies interaction. IVIg may also cause to  patients get a rash and doctors  recommended they take Benadryl or even steroids to avoid this. Remember their are a lot of antibodies and some may result in odd reactions. Kidney failure may result after IVIg if less fluids are given. Stroke or heart attack can happen after IVIg if the IVIg solution is pumped in at a fast rate.

A severe headache with a stiff neck after IVIg may be due to aseptic meningitis.

Variation in blood pressure, shortness of breath, back pain can also be seen after IVIg infusion. Serious conditions like encephalitis, myocarditis have been seen.

7. How can one reduce the side effects of IVIG?

  Remember to drink eight glasses of water a day for hydration before starting the IVIg treatment and continuing this a month after the last IVIg infusion. Some doctors recommend to take a baby aspirin to prevent thrombophelebitis. Patients need to check with their doctors if they can use aspirin and  should not take this if they are on coumadine or have bleeding disorders or if they have a history of  gastric ulcers. Doctors use Premedication  to help reduce side effects. Some recommend that one should take Tylenol or other NSAID for prevention of headaches and pains. Use a benadryl capsule for a rash and even to relax during the treatment. Using low dose prednisone will reduce side effects like headaches.

8. Where is the  IVIG treatment given?

IVIg can be given at home, in a doctors clinic or a hospital outpatient unit. Some patients have even taken IVIg at work.

9. What is the frequency of the IVIG treatment given?

Usually a IVIg  dose of 2 grams per kilogram is divided into five smaller doses of 400mg/kg, then this smaller dose is infused daily for 5 days. This is followed by a monthly IVIg infusion of 600mg/kg.  Patients who have side effects can take the IVIg treatment on alternate days. It is recommended that young women take this IVIg on alternate days.

10. What are the  differences in brands of IVIG?

Generally the difference between brands of  IVIg is in the amount of IgA content and also if the IVIg contains sucrose, glucose or some other sugar. Some IVIg products have Glycine while another one has no preservatives.

Different IVIg products match different patients. In general all the products work about the same. Some IVIg products have a 5% concentration others can be made 10%. The concentration of IVIg will make if thinner or thicker. CIDPUSA recommends a 5% solution for intravenous and a higher concentration for subcutaneous.

11. What is a recall OF IVIG? 

A recall of IVIg happens when someone reports defects in IVIg, side effects of a particular batch of IVIg. Then the FDA may issue a warning or a recall. This may also depend on contamination.

A recall of IVIg may be followed by shortage of the product in the market. Recently consumer demand for IVIg is surpassing production.

12. Where can I find out about recalls of IVIG? 

The FDA in the US maintains a current list of blood-product recalls on its site. This is because its members use so many different types of blood products, and generally store them in quantity. Look under Biologics and then recalls near the middle of page. http://www.fda.gov/cber/recalls.htm There you will find the IVIg products which have been recalled. FDA also has a page for consumers to report side effects of IVIg.

13. Who is a good provider for IVIG?

There are many nationwide providers of IVIG. . Some provide customized service for the patient.  They select the correct IVIG for the patient. They manage side effects Their nurses are well trained. They will also work with you on CO-PAYS and disease management. None of the providers should charge you a co-pay in USA.

Email  us for a good provider in your area.

14. What is the recommended dose as compared to age?

Children can tolerate a higher IVIg dose and the whole 3g/kg dose has been given without side effects as a single infusion. Young adults up to 25 years of age can tolerate  1g/kg of IVIg as a single infusion. Up to age 50 only 400mg/kg of IVig is recommended in one day.

When dealing with above 70 year old patients we recommend not to  infuse more then 400mg/kg in one week. Yes a higher dose of IVIg can be given but if the IVIg causes a stroke, heart attack, fainting then!

Please discuss above information with your doctor and providers. The above recommendations of IVIg are based on my experience and some of this is supported by current literature.

15. What is the right IVIG product for me?

• Patients with congestive heart failure or compromised renal function may fare better if they receive a IVIg product with a low osmolality and low volume;
   
• Patients who are diabetic should receive a IVIg product containing no sugars;
• Patients receiving IVIg products with sucrose may be at a higher risk for renal failure;
   
• Patients with immunoglobulin A (IgA) deficiencies should only receive products with the lowest amount of IgA or they could have anaphylactic reactions. Of course there are safer ways to infuse IVIg in IgA DEFICIENT PATIENTS. Hmm need to read our E-Book.
   
• Patients with small peripheral vascular access or a tendency toward phlebitis may want to avoid IVIg preparations with a low pH.

16. I have no more veins left and no central lines can be placed due to infections. How can I get IVIg?

   IVIg can be delivered by the subcutaneous route if venous access is a problem. This is the preferred way of delivery for a immune deficient patient.

  CIDPUSA have found that subcutaneous IVIg as a quicker and cheaper way to get better.

17.  IVIG and vaccination issue.

    IVIG prevents vaccinations to take any effect in your body.

Immunizations should not be given for at least 1 month and preferably 3 months after a course of IVIG.

If on IVIg you do not need routine flu shots. As you are getting  the antibodies. (Check with your physician).

Alternatives to IVIg are available and clinically proven. Please read our E-BOOK for detailed information.

For CIDPUSA by Dr Imran Khan MD Medical Director Nanotech Neurology and Anti ageing treatment Clinics of Excellence. Diplomate American Academy of Neurology Psychiatry

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